Five Year Forward View for Mental Health

The Five Year Forward View for Mental Health (FYFV-MH) sets out the national plans for improving and expanding care until 2021.

Professor Sir Simon Wessely (RCPsych past-President) was a member of the independent Mental Health Taskforce, which produced the FYFV-MH in February 2016.
All 58 recommendations were accepted by the Government in January 2017, including commitments to ensure access to high quality services for 1 million more people of all ages, and an additional £1bn of mental health funding by 2020/21.

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In 2015, we set up an independent Commission in response to widespread concerns about the provision of acute inpatient psychiatric beds and alternatives to admission available for patients.

The Commission was chaired by Lord Nigel Crisp, former Chief Executive of the NHS in England and Permanent Secretary of the UK Department of Health between 2000 and 2006.

The FYFV-MH and the Commission’s report (Old Problems, New Solutions) (pdf) were both published in February 2016. The Chair & Vice-Chair of the Taskforce were also Commissioners, which helped avoid duplication.

Both reports called for:

  • Eliminating inappropriate adult inpatient out-of-area placements.
  • Reviewing standards for acute psychiatric care.
  • Introducing a Patients and Carers Race Equality Standard.
  • Increasing patient and carer involvement.
  • Improving data.
  • Reviewing the mental health workforce.

In 2016/17, we worked with a wide range of stakeholders, including NHS England, the Cabinet Office, other Royal Colleges and voluntary sector organisations to implement the CAAPC recommendations.

To find out more, you can read our briefing summarising progress on implementation of the report one year after its publication (pdf).  

We hold the government and NHS leaders to account for delivery of the FYFV-MH.

We analyse data published by NHS England, NHS Digital and other national bodies to produce interactive tools that help our members understand:

  • planned spend
  • actual spend

on mental health services, both locally and nationally.

While progress has clearly been made over the past two years, the College recognises there is still much work to be done to achieve the FVFV-MH ambitions.

We want to support services to do this through our ongoing policy and research work in this area.

Our Deputy Head of Policy and Campaigns, Holly Paulsen, chairs the Mental Health Policy Group (MHPG), which consists of

  • the Centre for Mental Health
  • Mental Health Foundation
  • Mental Health Network
  • Mind
  • Rethink
  • Royal College of Psychiatrists.

MHPG members work together to improve mental health and influence the implementation of mental health policy.

We examined variation in waiting times for both urgent and routine eating disorder cases among children and young people using the Mental Health Five Year Forward View Dashboard from NHS England covering the first two quarters of 2017/18 (April-September).

All regions remain on track to meet the FYFV-MH waiting targets by 2021 (one week wait for urgent cases and four weeks for routine for 95% of patients).

But the analysis did reveal a gap of 16.7 percentage points between London (84.4%) and the North of England (67.7%) in the proportion of urgent cases seen within one week.

Mental health trusts’ income lower than in 2011-12

Our research published in February 2018 revealed that mental health NHS trusts and NHS foundation trusts in England, which provide the majority of secondary care mental health services, had £105m less income in real terms in 2016/17 than five years earlier. While around half of these organisations also provide community health services, the research underlined the scale of the challenge facing the sector in addressing long-standing underfunding, even with the recent injection of resources to help implementation of the Five Year Forward View.

The trust income research built on previous pieces of funding analysis:

Variation in child and adolescent mental health investment

We examined spending per head on child and adolescent mental health (including eating disorders) in 2016/17 using the NHS England dashboard data:

  • 33 of 209 CCGs (15.8%) were found to have reported spending less than £35 per capita.
  • 28 (13.4%) had reported spend of over £70 per capita.
  • There was a more than thirteen-fold difference between the highest and lowest spenders in this area across England.
  • 70 CCGs (33.5%) ultimately spent less than originally planned in 2016/17.

We have advocated that funding for CYP mental health needs to be protected to prevent it being spent for other purposes.

Mental Health Investment Standard

The College strongly welcomed the decision by NHS England to insist that from 2018/19 all CCGs must meet the mental health investment standard (MHIS).

MHIS stipulates that a CCG should increase its mental health investment at a higher percentage rate than its overall allocation growth.

Our analysis, published in June 2017 and based on Freedom of Information requests, determined that of 203 CCGs:

  • 29 (14.3%) were expected to fail to meet MHIS in 2017/18 
  • 21 (10.3%) were expected to in 2018/19.

We will continue to monitor CCG performance in this area closely as part of our regular examination of dashboard funding data, particularly the differences in planned and outturn CCG spend.

STP mental health spend

The inclusion of data at the level of sustainability and transformation partnerships (STPs) created another level of accountability through the dashboard. In March 2017, we evaluated whether STP footprints were planning to increase mental health investment in 2016/17 compared to the previous year. Of the 44 STPs:

  • 4 (9.1%) were found to be planning a reduction in spending as a proportion of their overall allocation
  • 9 (20.5%) were merely intending to increase investment by less than 2%.

Parliamentary work

We prepared tailored briefings for MPs from across England to provide them with the headline findings from the dashboard for the CCG(s) within their constituencies. A ‘drop-in session’ was held in Parliament to enable MPs and researchers to ask queries about the data face-to-face. The briefings have been used to support MPs in meeting with CCG leadership and prompt requests for more in-depth research on the dashboard data and beyond about the funding of and access to local mental health services.

We will continue to scrutinise implementation of the FYFV, both in relation to access to services and frontline funding, with regular pieces of research and analysis to monitor trends and highlight variation. 

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